Lethal Area 50 in Patients with Burn Injuries in North West, Iran

Estimating mortality risk in burn patients admitted at Rwanda's largest referral hospital

BACKGROUND

Burns is a disease of poverty, disproportionately affecting populations in low- and middle-income countries, where most of the injuries and the deaths caused by burns occurs. In Sub-Saharan Africa, it is estimated that one fifth of burn victims die from their injuries. Mortality prediction indexes are used to estimate outcomes after provided burn care, which has been used in burn services of high-income countries over the last 60 years. It remains to be seen whether these are reliable in low-income settings. This study aimed to analyze in-hospital mortality and to apply mortality estimation indexes in burn patients admitted to the only specialized burn unit in Rwanda.

METHODS

This retrospective study included all patients with burns admitted at the burn unit (BU) of the University Teaching Hospital in Kigali (CHUK) between 2005 and 2019. Patient data were collected from the BU logbook. Descriptive statistics were calculated with frequency (%) and median (interquartile range, IQR). Association between burns characteristics and in-hospital mortality was calculated with Fisher's exact test, and Wilcoxon rank, as appropriate. Mortality estimation analysis, including Baux score, Lethal Area 50 (LA50), and point of futility, was calculated in those patients with complete data on age and TBSA. LA50 and point-of-futility were calculated using logistic regression.

RESULTS

Among the 1093 burn patients admitted at the CHUK burn unit during the study period, 49% (n=532) had complete data on age and TBSA. Their median age, TBSA, and Baux score were 3.4 years (IQR 1.9-17.1), 15% (IQR 11-25), and 24 (IQR 16-38), respectively. Overall, reported in-hospital mortality was 13% (n=121/931), LA50 for Baux score was 89.9 (95% CI 76.2-103.7), and the point-of-futility was at a Baux score of 104.

CONCLUSION

Mortality estimation indexes based on age and TBSA are feasible to use in low-income settings. However, implementation of systematic data collection would contribute to a more accurate calculation of the mortality risk.

Profile of patients with burns according to seasonal changes

OBJECTIVE

In this study, the aim was to discuss the effects of seasonal changes on the patient profile and number of patients hospitalised at our burn centre.

METHOD

All cases of burns that occurred between 1 January 2014 and 1 January 2020 at our hospital were investigated.

RESULTS

In total, 1417 patients were investigated, 799 of whom were male (56.4%) and 618 (43.6%) were female. The number of patients with burns in the 1-4 years age group was the highest of all the age groups. Scald burns and electrical burns were mostly observed in the spring; flame burns were mostly observed in the winter, and hot object contact and chemical burns were mostly observed in the summer. When considered in total, burn cases were mostly observed in spring and autumn.

CONCLUSION

Understanding seasonal epidemiology of burn injuries can facilitate seasonal injury prevention campaigns and education efforts. Burn centres can also allocate resources appropriately, according to the patient volume and possible burn outcomes for each season.

The Epidemiology of Burn and Lethal Area of Fifty Percentage (LA50) in Children in Shiraz, Southern Iran

BACKGROUND

This study was conducted to assess the epidemiology of burn and lethal area of fifty percentage (LA50) in children in Shiraz, Southern Iran.

METHODS

In this case series study, 619 hospitalized burn children from burn centers affiliated to Shiraz University of Medical Sciences, Shiraz, Iran from 2012 to 2016 were enrolled. Demographic characteristics of patients such as age, gender, place and cause of burn, and morality rate were evaluated. LA50 was measured using Probit analysis.

RESULTS

The mean age of patients was 4.4±3.4 years. The mortality rate in burn patients was 8.7% and LA50 of total body surface area (TBSA%) ranged from 40.1% in 2012 to 68.3% in 2016. Although the number of male burn patients (65%) was more than females (35%), the mortality rate in females was more than males (11.4% vs. 7.2%). Scald and flame were the most common causes of burn.

CONCLUSION

The findings in our burn center comparing burn patients to developed countries showed that LA50 and survival rate were lower denoting to an urgent necessity to promote current policies in burn care and prevention and to decrease the mortality rate too.

Mortality data 2004-2019: an audit of the Royal Adelaide Hospital Adult Burn Service

BACKGROUND

Burns are complex, multifaceted injuries that can pose significant challenges to the treating team. The Royal Adelaide Hospital (RAH) Burns Service has undergone a major evolution over the past two decades, with perceived improvement in outcomes. We present here a longitudinal audit of the RAH Burns Service Mortality Data between 2004 and 2019.

METHODS

An audit was conducted of all index admissions to the RAH Burns Unit from 1 January 2004 to 31 December 2019. Age at admission, total body surface area, burn depth, presence of inhalation injury and outcome were recorded. Baux and revised Baux Scores were calculated. Lethal Area 50% for different time points and age groups, Baux_50/100 and Revised Baux_50/100 values were then calculated using logistical regression.

RESULTS

During 2004-2019, there were 5653 index admissions to the RAH Burns Unit. The mean total body surface area of burn injuries admitted was 5.1% and the survival rate was 99.17%. The Lethal Area 50% for the study period was 74%, with an improvement from 70% (2004-2011) to 80% (2012-2019). The Baux₅₀ score for the time period was 120 and the Revised Baux₅₀ was 129.

CONCLUSION

The RAH results are comparable with other high-income country Burn Services and demonstrated significant improvement across the study period. The data also highlight areas for ongoing focus such as the elderly burns patient.

Epidemiology and the survival rate of burn-related injuries in Iran: a registry-based study

Burns are considered an important preventable fraction of injuries in low and middle-income countries, and are still a leading cause of death in Iran. This study investigates features of burns in Sina Hospital's Burn Centre in East Azerbaijan Province in order to calculate survival and mortality rates as well as factors affecting mortality in this centre. In this cross-sectional study, demographic characteristics of patients such as age, sex, cause of burns, type of burns, length of stay (LOS) in the hospital, total body surface area (TBSA), anatomic distribution of burn, mortality rate and final status of patients at the time of discharge from hospital (recovery, death) were investigated. The total mortality rate was 6.84%. Hot liquid burns and gas cylinder explosion burns were among the most common. Burns on multiple regions of the body (45.9%) and pelvic and lower limb burns (22%) constituted the next most common injury. In the TBSA index, compared to reference categories (extent of burn less than 50 percent), the categories of 50-59, 60-69, 70-79, 80-89 and over 90 percent indicated lowest survival based on the Log-Rank test. Hazard ratio for burns greater than 10% was 15.33 fold. Total body surface area burned of over 10% constantly increases the instantaneous risk of mortality therefore there is a need to enhance the quality of care provided to burn victims.